1. Photo by: Sirisak Chaiyasook S creening A ssessment R eferral & T reatment S creening A ssessment R eferral & T reatment

2. Our Community’s Efforts The Carroll County Fetal/Infant Mortality Review Board and Community Providers noticed an increase in substance abusing pregnant women A Community forum was held in April 2008 by the Carroll County Health Department (CCHD). In attendance were various community agencies and providers. Following the Community forum, the CCHD and Alcohol and Drug Abuse Administration (ADAA) attended the monthly Obstetrician’s meeting at Carroll Hospital Center (CHC) to address the concerns of practitioners about methadone dosing in the community.

3. Our Community’s Efforts The Local Management Board, CCHD, CHC, Partnership for a Healthier Carroll County, and Carroll Community College invited Dr. Ira Chasnoff, of the Children’s Research Triangle in Chicago, to speak at workshops on June 17 (providers) and June 18 (community) 2009. 24 practitioners and 165 community members attended. A workshop on September 2, 2009 was planned with a speaker from the National Organization on Fetal Alcohol Syndrome (NoFAS). The training offered CEU’s and CME’s.

4. Scope of the Problem Carroll County (in County birth data) 10/08- 9/09 CHC Deliveries1,145 Positive Toxicology Screen 115 (10% of 1,145) Special Care Nursery Admissions 248 Neonatal Abstinence Syndrome admissions 11

5. Carroll Statistics Fiscal YearTotal # of Pregnancies Projected # using Alcohol Actual Referrals to TX FY08 1,749 (CY) All Carroll County births 175 (10% of total) 26 (15% of projected #) FY09 1,572 (CY) All Carroll County births 157 (10% of total) 15 (9.5% of projected #) FY10 1,178 Carroll Hospital Center only 118 (10% of total) 12 (10% of projected #)

6. Common Myths About Substance-Abusing Women 1.Only poor, minority women use drugs and alcohol during pregnancy 2.Women will stop using drugs when they find out they are pregnant 3.If you give an addicted woman a choice between her baby and her drug, she will always choose her baby

7. Common Myths About Substance-Abusing Women 4.Treatment doesn’t work 5.Traditional drug treatment methods are equally effective for all populations, even across gender and culture 6.By third trimester, it is too late to do anything that will help the baby

8. Substance Abuse Newborn Complications Low birth weight Prematurity Failure to thrive Sudden Infant Death Syndrome Malformations Brain damage

9. Our Community’s Response Leadership Institute at Children's Research Triangle Carroll County Team: Cathy Baker, RN, CCHD, Assistant Director Bureau of Addictions Dr. Michael Beardsley, Carroll County Pediatrician Martha Clark, PhD, LCSW, Department of Human Resources, State of Maryland, Policy Analyst Susan Doyle, RN, CCHD, Director Bureau of Addictions Dr. Teresa Fuller, CHC, In House Pediatrician Linda Grogan, RN, CHC, Director of Nursing for OB and Pediatrics Diane Jackson, MA, Adult Drug Treatment Court Coordinator Cindy Marucci-Bosley, CRNP-OB/GYN, CCHD, Director of Nursing Jolene Sullivan, Director of Citizens Services Suzette Tucker, ADAA, Regional Director & State oversight of Senate Bill 512 Dr. Imelda Udo, Carroll County Obstetrician

11. Carroll County SART Plan Vision It is our vision to: Identify pregnant women who use substances and/or who are at risk for depression and domestic violence through uniform screening Refer at-risk women to programs that will provide treatment and support Ensure all children are brought home to a safe and nurturing environment with ongoing supportive services

12. Carroll County SART Plan Foundational Beliefs This plan is based on the following research based knowledge: 1.No amount of alcohol, tobacco, or illicit drug use in pregnancy is safe 2.Parents who are healthy, nurturing, and free from substance use and violence can provide the home that a child needs for healthy growth and development 3.Quality health and human services are effective if they are well matched to the needs of the persons; i.e., gender-specific and culturally appropriate 4.Prevention and early intervention services save lives and save money 5.The health of our community depends on our ability to work together across organizational boundaries

13. Carroll County SART Plan Three Guiding Concerns This plan depends on dynamic balance of three guiding concerns:  The health and well-being of children and families affected by alcohol, tobacco, and illicit drugs; depression; and domestic violence  The success of care providers; and  The responsible allocation of resources

14. Carroll County SART Plan Healthy Children and Families Successful Effective and Care ProvidersResponsible Use of Resources

16. Role of the Primary Care Provider Identify all pregnant women at risk for substance use Conduct a field assessment on women who screen positive Conduct a brief intervention with all women who have a positive field assessment Refer any woman who needs further assessment or treatment to an appropriate program Screen for related problems such as: HIV, Hepatitis B, & Hepatitis C infection, depression, and domestic violence

17. Successful Screening Is only a first step in the process of screening, assessment, referral, and treatment Over-identifies women at risk for substance abuse, depression, and domestic violence Is fast, simple, cost effective, and efficient

18. The SART System S creening A ssessment R eferral T reatment

19. Screening Instrument Identifies women at risk Takes only a few minutes Requires minimal training or expertise Is most successful when integrated into the context of primary health care Is completed at two points during the woman’s care – at first prenatal visit and at admission to labor and delivery

20. The 4P’s Plus © Screen for Substance Use in Pregnancy P arents Did either of your parents ever have a problem with drugs or alcohol?

21. The 4P’s Plus © Screen for Substance Use in Pregnancy P artner Does your partner have a problem with drugs or alcohol? Is your partner’s temper ever a problem for you? Does your partner threaten to hurt or punish you?

22. The 4P’s Plus © Screen for Substance Use in Pregnancy P ast Have you ever drunk beer/wine/liquor? Have you ever felt out of control or helpless? In the past two weeks, have you ever felt down, depressed, or hopeless? In the past two weeks, have you lost interest in doing the things that used to be fun for you?

23. The 4P’s Plus © Screen for Substance Use in Pregnancy P regnancy In the month before you knew you were pregnant, how many cigarettes did you smoke? In the month before you knew you were pregnant, how much beer/wine/liquor did you drink? In the month before you knew you were pregnant, how much marijuana did you smoke?

26. The SART Team would like to thank the LMB for their support of the initial Educational Program which allowed us to implement this new screening to better serve our County

27. The 4P’s Plus © Screen for Substance Use in Pregnancy Thank you… Questions?